Closed versus open suction systems to prevent ventilator-associated pneumonia

Abstract

Overview of the Topic: Ventilator-associated pneumonia (VAP) is the most common healthcare-acquired infection in mechanically ventilated patients and contributes to 20% of the mortality rate in the intensive therapy unit (ITU). Closed suction systems (CSS) and open suction systems (OSS) are the two forms of endotracheal tube (ETT) suctioning. However, it is not clear which one of these methods is the best option for VAP prophylaxis. Thus, this dissertation is a literature search to investigate whether CSS, compared to OSS, decreases VAP in mechanically ventilated patients. Research Question: In mechanically ventilated patients, does a closed suction system, compared to an open suction system, decrease the risk of ventilator-associated pneumonia? The PICO Elements: The population (P) studied were mechanically ventilated patients. The intervention (I) was CSS. The comparison (C) was OSS. Finally, the outcome (O) was a decreased risk of VAP. Method: After identifying the PICO elements alternative terms were found. These key terms and their synonyms were then used for the search strategy using several databases. Boolean Operators, truncations, wildcards were used for the literature search along with inclusion and exclusion criteria. The PRISMA flow diagram identifies the selected six eligible studies. These studies were critically appraised using the CASP checklists for RCTs and cohort studies to ensure that essential factors are included in the articles to increase consistency. Results: Five studies found no significant difference between CSS and OSS in preventing VAP, and only one of the six studies rejected the null hypothesis. The Implications and Recommendations: More research must be performed on this subject, especially locally. Nurses should adhere to the proper suctioning method, focusing on maintaining an aseptic technique while management provides guidelines to the multidisciplinary team.